HomeMy WebLinkAbout1111 VALLEY CIR - Building PermitsCaller's N
Address
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CITY OF COSTA MESA
SERVICE REQUEST & PUBLIC ASSISTANCE FORM
Date
Time
Phone :�R4� t
Nature of Request: (location. type, severity) /%
Referred to
Call back
Service Only
Information Only
Person Receiving Call
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28124
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92818
For Applicant to Fill In Completely
TYPE OR PRINT
COSTA MESA. CALIFORNIA
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RECEIPT NO.
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DESCRIPTION OF
WORK
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I RSRE[YAC [00[ THAT 1 NAV[ READ THIS APPLICATION
AND OTATB'T T THE ASOVE 19 CORRECT AND AOREE TO COM.
PLY WITH ALL CITY OROINANC[9 AND STAT[ LA O R[OYLATINO
BUILDING CONSTRUCTION. /' v
SIGNATURE OF / 1� /
PERMITTE
AUTHORIZED AGtNT
JAA.4 6-6 .' 0 582* ****94.50
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO.
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NOTE: NO HAVQ OVERHANG SHALL BE L688 THAN
O 8106 a REAR P. L.
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WBD (U. B. C. REQUIREMENT)
ARDS APPROVED
YARDS APPROVED
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ACCESSORY BUILDING
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BO. PT.
THE AMOUNT SHOWN UNDER VALUATION IB POR -
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION /
PERMITFEE $ (�
PLAN CHECK 5
TOTAL FEE 6-4